Simultaneous Versus Staged Surgery for Double Crush Syndrome of Cervical Radiculopathy and Peripheral Nerve Compression at the Wrist

Abstract

Study Design. Retrospective single-center study. Objectives. To evaluate the results of surgical treatment in patients with double crush syndrome associated with cervical radiculopathy and upper limb peripheral nerve compression after staged and simultaneous operations. Summary of Background Data. Currently, choosing the optimal diagnostic and therapeutic modalities for treating patients with double crush syndrome remains unresolved. Methods. The study included 79 patients with double crush syndrome (cervical radiculopathy and syndrome of Guyon’s canal or Carpal tunnel syndrome). Two independent groups were studied: In the Staged Group (n=35), we performed a cervical decompression with stabilization and peripheral nerve decompression at separate days due to ongoing clinical symptoms (average interval between interventions being 22 (18;26) days). In the simultaneous group (n=33), we performed both the cervical spine surgery as well as the peripheral nerve procedures in one surgical session. Total operative time, estimated blood loss, length of hospitalization, complications, and clinical data (NDI score, SF-36, VAS neck pain score, VAS arm pain score, Disabilities of Arm, Shoulder, and Hand (DASH) score, and Macnab scale) were compared. We used the Mann-Whitney (MW) test for intergroup comparisons, the Wilcoxon criterion for dependent samples, and the Fisher exact test for binomial parameters. Results. There was a significantly lower operative time, duration of inpatient treatment, and temporary disability in the simultaneous group (P=0.01, P=0.04, and P=0.006, respectively). Comparative analysis did not reveal significant intergroup differences using NDI, VAS, and DASH (P>0.05), whereas, at discharge, significantly better clinical parameters were appreciated for the simultaneous group using SF-36 and Macnab scores (P=0.04 and P=0.03, respectively). At the last follow-up, an intra-group analysis revealed comparable clinical effectiveness between the two approaches (P>0.05). Conclusion. Comparison of the effectiveness of simultaneous and staged surgery revealed comparable long-term clinical outcomes. However, simultaneous surgery conveys clinically important advantages in terms of surgical time, anesthesia duration, length of hospitalization, and patient disability. Level of Evidence. 3